Non-Evidence Based Practice Happens More Often Than People Want To Admit
You walk onto a med-surg floor and within an hour you see someone misting a COPD patient on room air at two liters because that is what their charge nurse always did. Nobody checked the literature. The habit just got passed down through shift changes for twelve years. That is non-evidence based practice and it is not unusual. It is the default in a lot of units. Here are the ones I actually see documented or witnessed repeatedly across different hospital systems. They are not rare. They are routine. Turning postoperative patients every two hours without assessment. The old schedule came from a 1950s textbook. Current guidelines from the American Association of Critical-Care Nurses and wound care evidence support individualized turning schedules based on skin integrity, hemodynamic stability, and pressure injury risk scores. I worked a surgical floor where the policy literally said "turn q2h" with no exceptions. Nurses spent more time rolling patients than doing actual assessments. We started documenting pressure injury risk with the Braden scale on admission and adjusted turn frequency based on score and skin appearance. It cut unnecessary repositioning by roughly half and actually improved our pressure injury rates because we were spending time on the patients who needed it most instead of treating everyone identically.
Using ice packs for injection site pain. There is no solid evidence that cold therapy reduces pain from intramuscular injections. Some units still do it because someone in the 1990s thought it was a good idea. What actually has evidence behind it is z-transference technique, aspirating before needle withdrawal only when using certain medications, and using the ventroglaneeal site for adults when appropriate. The ice thing just keeps happening. Bending a patient's arm after venipuncture as the primary hemostasis method. Pressure is what stops bleeding. Bending the arm increases the risk of hematoma formation, particularly in elderly patients or those on anticoagulants. I saw a patient develop a large antecubital hematoma after a routine lab draw because the phlebotomist had her hold her arm flexed for five minutes. The evidence is clear: straight arm pressure with a gauze pad for two to three minutes is more effective and safer. Making patients NPO at midnight for morning procedures. ASA and ASER guidelines support clear liquids up to two hours before surgery and solid food up to six hours for low-risk patients. Keeping everyone NPO from midnight causes dehydration, insulin resistance, and prolonged postoperative recovery. I managed a preoperative unit where we implemented a modified fasting protocol. Patient satisfaction scores went up and there were fewer call lights for water. The surgeons initially resisted. Once they saw the data on delayed surgeries caused by patient discomfort and agitation, they stopped complaining.
Restraint use as a first-line intervention for confusion. Physical or chemical restraints for agitated or confused patients, especially those with dementia, are not supported by current evidence and are associated with increased mortality, longer stays, and worse outcomes. I once cared for a patient with advanced Alzheimer's who was placed in wrist restraints because "he kept pulling lines." We spent three days trying to get the restraints removed. The real problem was sleep deprivation and unmanaged pain. Once we addressed those, the pulling stopped. The restraints were never needed. Normal saline flushes before and after every medication administration. This is one of the most pervasive examples of non-evidence based practice I have encountered. Drug compatibility databases show that many IV medications are compatible with each other and do not require saline flushes between them. A 2016 study in the American Journal of Nursing found that routine saline flushing before and after meds added significant time to medication administration without improving line patency in most cases. Many institutions have moved to compatible med-only protocols, but a lot of floors still flush everything because the policy has not caught up. Bladder scans as a routine order for postoperative urinary retention screening. There is no strong evidence supporting routine bladder scanning in asymptomatic postoperative patients. It leads to unnecessary catheterizations, which increase UTI risk. I worked in a unit where every post-op patient got a bladder scan at four-hour intervals. We ended up placing more foleys than the surgical service wanted. We switched to clinical assessment only, with scans reserved for patients showing signs of retention. Our catheter-associated UTI rates dropped noticeably within six months.
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Why These Practices Persist
The main reason is institutional inertia. Policies get written once and never revised. New evidence comes out annually and most nurses never see it. Charge nurses pass down habits. Orientation teaches the old way. The system does not actively correct course. A secondary factor is liability fear. It is easier to document that you followed an outdated policy than to make an independent clinical judgment that might be questioned later. Cover-your-base practice is a major driver of non-evidence based nursing.
How To Identify And Correct Non-Evidence Based Practice
Start by questioning any routine that feels arbitrary. If you cannot explain why you do something beyond "this is how we always have," that is a red flag. Look up the current guideline. Cochrane reviews, JBI evidence summaries, and professional organization position statements are the fastest routes. When you find a gap between practice and evidence, document it. Write up a brief summary with the recommendation, the source, and the potential impact on patient outcomes. Take it to your wound care nurse or evidence-based practice committee. Most hospitals have one, even if nobody uses it actively. Change happens slowly at the unit level. You will not rewrite policy overnight. But you can model the evidence-based behavior consistently. Other nurses notice. Eventually it spreads. The ice pack example above took about eighteen months to fully phase out on my unit. Eighteen months of people asking why we stopped, then acceptance, then nobody remembered the old way at all.
The hard truth: some non-evidence based practices persist because they are cheap or convenient, not because they work. Recognizing that distinction is the first step toward actually changing practice.
